Surgery

I had the honour of being the student of Dr.Mrs. M.J. Mehta. She was a giant of a general surgeon and truly the last of the ilk. She taught us the value of work. She taught us how to appreciate someone else’s pain and suffering. She was exceptional in her clinical judgment exceptional in operative skills and exceptional in post operative management. I have never seen any other surgeon with all these three qualities together at their highest. She taught me the basics of surgical techniques. I never saw her doing a surgical mistake like unknowingly cutting a structure, or closing the abdomen with some bleeder inside. I never saw her doing a hurried job to attend some function.

I did almost all kinds of abdominal surgeries, surgery for oral and oesophageal cancer under her guidance and people though I was a good surgeon all credit goes to her.

Here is what I have to say about her.

Prof. Dr. Mrs. Mehru J. Mehta : Legend in Lifetime

It's now twenty-five years that I got my registration in surgery at the Sassoon Hospitals and B.J. Medical College. I had decided to register under Dr. Mrs. Mehta and therefore I went for the interview in her office a few days prior to taking the post of Junior Resident. Madam was busy looking at some papers on her table. Of course we knew Dr. Mrs. Mehta since our undergraduate days but it was always from a distance. She had a terrific presence what with her great reputation as a surgeon, her smoking and now unbelievable temper. I was rather terrified to talk to her for the first time. She looked at me over her spects and asked me, “Do you realise young man what it means to work in my wards?” Mustering as much confidence in my voice as possible I said, “Yes Madam!” “What yes? You will have to work twenty four hours in my wards.” She said. Cold sweat broke on my back. Still I managed to say “Yes Madam.” She gave me a look of complete disbelief and asked me to see her tomorrow in ward nine at eight o’clock sharp.

Next day I found her sitting beside a patient and drawing with a syringe a most foul smelling liquid from a tube and emptying the syringe in a kidney tray. When the tray was full she looked around and saw me standing there. A question mark appeared on her face. “I am your new junior resident madam!” I managed to inform her. “O. K. Take this kidney tray, clean it and bring it back.” She said. I had the conceit of a newly hatched MBBS doctor and of course thought that this was not my work. I called the ward boy and he disappeared after saying “Yes, coming.” Madam filled another syringe and turned to empty it. She found me standing there with the full kidney tray on the table by my side. She became angry and told me,” I told you to clean this.” “I have asked the ward boy.” I said. “Ward boy? My foot!!! Take this yourself and clean it with your own hands. Get out of here.” She was extremely angry. I lifted that awfully filthy and foul smelling tray and started towards the basin. I felt like vomiting which I suppressed with great effort. I had not washed even my own dish before. I felt humiliated. I started cleaning the kidney tray and as it sparkled I had a certain realisation that if I am going to learn surgery it is going to be under Dr. Mrs. Mehta and nobody else.

She gave a practical demonstration to stress that no work is inferior. All work is equal. After this episode I saw her cleaning beggars herself with soap and water, lifting urine pots and giving bed pans. We saw her feeding patients with food from her own tiffin. Sometimes she would herself taste the food meant for the patients thus ensuring some minimum quality. We saw her monetarily helping poor patients. We could see for ourselves a saint at work helping the poorest of the poor.

It's of no use having real concern for the patients if you do not have ability to arrive at a correct diagnosis, exceptional skill at surgical procedures and operations and very meticulous postoperative care. We saw all these three qualities together in her. But it was extremely difficult and demanding hard work for us. She used to be in the wards right from eight o’clock till eleven o’clock at night. We had to implement her orders and instructions after she went away thus getting back to quarters at twelve o’clock. On the operation day we had to be back in the wards by five o’clock to prepare the patients. It was impossible to sleep two hours at a stretch as invariably some urgent night calls had to be attended in the wards. Before proceeding to the theatre it was mandatory to see all the patients, check their orders, start intravenous fluids & do some dressings. It was impossible to give any excuses, although there were at least eighty patients in her wards when the capacity was only forty, because she herself used to do any odd work like lifting urine pots giving bed pans etc. Any sloppiness and we used to get such a firing that it was not possible to commit the same mistake twice. She used to scold us in the presence of staff nurses, ward boys, patients' relatives and patients, never pretending to pamper our false pride as doctors. She knew for certain that a mistake has to be punished immediately there only, as any postponement not only gradually reduces the gravity of that mistake but leads to even acceptance of these mistakes as routine occurrences. We used to be really mad at her for her scolding. We used to feel insulted and humiliated. Everyday one used to feel like running away from all this. There was no question of going home, no meeting friends, no meals on time, not even two hours sleep at a stretch, extreme work load and no pardoning for any mistake. But we knew in our hearts that surgery does not mean cutting, removing and stitching it back. A few minutes surgery is carried by the patient for his life time therefore there is no place for inefficiency. We knew by instinct that this woman knows the soul of surgery and this certainty carried us through that difficult period.

In spite of all this we had total freedom to disagree with her regarding diagnosis, treatment and management of patients. It was rarely in a blue moon that one of us was right and she was wrong. She wholeheartedly accepted her mistake and credited even the junior most person with whatever was due to him. Such instances really used to buoy us to work even better and harder. If someone suggested a new way of dressing or a new technique of operation she used to give it due consideration and accept it immediately if she felt so. Once we were operating for eight to ten hours and at the end of the operation two ultra thin vessels were to be joined which required great skill and patience. She did that and when the clamps were released we found that the anastomosis was getting twisted with the flow of blood through these vessels. Madam looked up. Everybody was tired. “Sorry boys. We have to redo it.”, She said and proceeded to undo the anastomosis and redid it well. When she was satisfied with it she asked us to close. We were standing for twelve hours without a drop of water or a morsel of food. We dared not complain about it. She taught us, without uttering a word, the importance of quality of work against all odds.

In those days the concept of surgical intensive care unit was not in vogue, but Madam had the foresight to keep two special beds in our ward where we used to look after the patients twenty-four hours. She bought the respirator for our ward and learned to use it along with us. She was fifty then but still learning. She taught us to be students for life. So many patients came back from jaws of death with that machine. There was hardly any time for celebration though as another one was hooked on to it almost immediately.

Madam is especially interested in oral and oesophageal cancer and she is without par in these two surgeries. In addition oesophageal varices is another of her specialities. In liver cirrhosis the veins at the junction of oesophagus and stomach dilate to such an extent that they burst ensuing massive haemorrhage and timely intervention if not available means certain death. Before the advent of sclerotherapy the treatment for this disorder in itself was very risky. Madam used to perform this surgery with consummate ease. We never saw her panic under extremely trying conditions. It can be truthfully said that in fact she could operate on any organ with equal authority. She is truly the last great general surgeon. She used to operate on cases rejected by other surgeons as too risky and come out with flying colours in many. In many such instances she used to be criticised for doing ultra radical operations. We asked her once about this and the reply was as straightforward and honest as she only can give. “Everyone has a right to live. We are here to help people. We must do our work with full attention and care and not worry about results.” We felt as if we were hearing,” You have right unto your work and not unto fruits thereof.”

Once a diabetic patient had such severe infection in his leg that it was almost certain that he needed an amputation and the patient was not ready. Madam spent inordinate amount of time convincing the patient the need of this drastic step. We all got extremely irritated with the patient and madam as well. Madam told us very calmly,” It is very difficult for anybody to take this decision. Who will like to see his own body thus mutilated ? We must understand his situation.” We learnt that it is extremely important to take patients' opinion and not to think that we as surgeons are superior beings who can take hasty decisions about someone else’s body.

Such was her reputation that people used to come from far off places simply to avail themselves of her healing knife. Once a father and son pair came all the way from Bihar. The young son had completely stenosed stomach and hence food was not going beyond his stomach. He was simply skin and bones. He was treated well and it is hard to forget the sight of father and a healthy looking son repeatedly bowing down before madam and praying to god for her. This reputation was extremely hard on us as anytime people used to be admitted our work used to go on multiplying with no end in sight. We had to prepare his papers, examine him, send his investigations after filling all kinds of forms in addition to the daily work. We used to feel crushed with work. All the same “Madam” was the focal point of our life and it used to revolve round questions like, “What will madam say? What will madam feel? Madam said this. Madam did that. Etc.” Madam was our teacher to begin with but soon became our mother and went on to become our mentor.

It was not all work and no play. Some incidents were really funny and relieved our stress to a considerable extent. We had a patient who had a very malignat tumour and he was schizophrenic as well. Madam was telling him something but he would not listen. Finally madam asked him, “Look here Narayan. Who is the big doctor here?” Narayan pointed his finger towards me as I was the tallest among the lot. Madam was aghast. She told him,” Narayan, he is the youngest. He does not know anything. I am teaching him. I am the big doctor here.” But Narayan never accepted this.

We could never discern any change in behaviour when she used to look after big political leaders, government officials. She did for them as she did for poor people. We realised that all patients were VIPs for her and she never wanted VIPs as her patients. Her behaviour with us changed with time and she started calling us her colleagues and behaved as if we were her equals. Although she was our mentor she never, even once, told us to do any of her personal work but insisted to get anything that was not available in Sassoon from anywhere in Pune. Patients on artificial respiration needed repeated blood checks to determine their oxygen content and we used to go to other hospitals any time of day and night to get that report. She even used to call outside surgeons to operate on cases outside her field. The day before the operation she used to check herself the availability of electricity, water, oxygen, blood, suture material and many other things till she had enough confidence in us to do it. Thus Madam’s Operation day was so charged with tension that we could feel it in air. If suddenly she found out that something was not available then the concerned person had a firing of his lifetime. Till the theatre started and she started operating for sometime we could never breathe peacefully.

Once the patients settled after the operations she taught us and that too with great simplicity. This teaching could be bedside or in her room or in the ward side room. She never gave us holidays before the examination. We could see all our friends reading and studying like possessed persons and we used to work in wards. But when we started to read we found that we were reading what we were doing in the wards.

All great people are likened to a jackfruit. Extremely thorny outside but if you can manage those thorns then there is a certainty of getting extremely juicy and sweet kernels. This simile is very apt for Dr. Mehta. Those who were frightened looking at the thorny side got only pain. Those who were bestowed with enough intelligence by the Almighty tolerated the initial pain and their life was made. We did not even know when we started eating fish and rice from her tiffin without her knowledge, when only a few years back we used to tremble standing before her. When she used to find that fish is finished she used to be mockingly angry and we used to pacify her by offering a cup of tea. People who refused to donate blood, to save the life of their mother or father or a husband who could shamelessly declare that he would marry again but not give blood for his dying wife, got severe tongue lashing but talking to patients she was compassion incarnate. Even after she left Sassoon she has many times paid bills worth thousands of rupees for poor patients. We used to have supernumerary residents who used to work as hard as us but never used to get money. Madam has paid them from her pocket.

Whenever I used to read passionate accounts of people writing about their mentors, I used to feel that they are overdoing a bit. When I encountered such a “Guru” myself I realised the honesty of those accounts. As the years are passing I am realising more and more the importance of what she did for us in our formative years. Without her we could never have even a glimpse of the deeper meanings and purpose of life. All her students are saluting this great teacher on the occasion of her seventy fifth birthday on 10th June at the B. J. Medical Auditorium. Everyone can join to felicitate her.

I had chance to work as a surgeon at the Dr.Bandorawalla Leprosy Hospital and there I did a lot of plastic surgery especially tendon grafting and transplants for four years. We developed a method of rehabilitating hand following surgery and developed a method of rehabilitation for tarsal disintegration. This opportunity was given to me by Dr. Jal Mehta. We published two papers in Indian Journal of Leprosy.

In Germany I worked in Dreifaltigkeitskrankenhaus fuer Orthopaedie und Sporttraumatologie for nine months. There I participated in various orthopaedic procedures and learnt some technical details of sports injuries rehabilitation.